Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (OD/OER)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 Parent/Guardian Interview Survey	Form	New	Available
Form 3 Adolescent Interview Survey	Form	New	Available
Form 2 Parent/Guardian Recruitment Screener and Consent Form	Form and Instruction	New	Available
Form 1 Adolescent Recruitment Screener and Consent Form	Form and Instruction	New	Available
Form 1 PHP Screenshots	Form and Instruction	New	Available
Form 1 Survey Screenshots	Form and Instruction	New	Available
Form 1 Attachment 2_NLM SIS Anatomy Physiology Portal Resources Survey Instrument Screenshots	Form and Instruction	New	Available
Form 1 Attachment 2_NLM AIDS Portal Survey Screenshots	Form and Instruction	New	Available
Form 1 EDI Customer Service Survey	Form and Instruction	New	Available
Form 1 NLM LO Outreach Focus Group Survey Tool	Form and Instruction	New	Available
Form 1 Survey	Form	New	Available
Form 1 Interview Guide	Form and Instruction	New	Available
Form 2 Script	Form	New	Available
Form 1 Survey Screenshots	Form and Instruction	New	Available
Form 1 Moderator Guide -Young Faculty	Form and Instruction	New	Available
Form 2 Woman Physician-Scientist -Interview Guide	Form and Instruction	New	Available
Form 1 Research Dean Interview Guide	Form and Instruction	New	Available
Form 1 Recruitment and Screening Form	Form and Instruction	New	Available
Form 2 Research Student Modertaor Guide	Form and Instruction	New	Available
Form 3 Young Faculty Moderator Guide	Form and Instruction	New	Available
Form 1 Online Survey	Form and Instruction	New	Available
Form 1 Telephone Survey	Form and Instruction	New	Available
Form 1 Finding Aid Survey	Form and Instruction	New	Available
Form 1 NCI Patient Education Publications Survey	Form and Instruction	New	Available
Form 1 Client Survey	Form and Instruction	New	Available
Form 1 EAI Satisfaction Survey	Form and Instruction	New	Available
Form 1 Traveling Exhibition Host Survey	Form and Instruction	New	Repair queued
Form 1 Train-the-Trainer Workshop Feedback Survey	Form and Instruction	New	Available
Form 2 Researcher Survey Text Version	Form and Instruction	New	Available
Form 1 Researcher Survey	Form and Instruction	New	Available
Form 1 Advocate Interview Guide	Form and Instruction	New	Repair queued
Form 1 Omnibus Survey	Form and Instruction	New	Available
Form 1 NCCAM Clinical Digest e-Newsletter Survey	Form and Instruction	New	Repair queued
Form 1 IHM Survey	Form and Instruction	New	Available
Form 2 Parent Survey	Form and Instruction	New	Available
Form 1 Customer Satisfaction Survey	Form and Instruction	New	Available
Form 1 NCAAM Clearinghouse Telephone Survey	Form and Instruction	New	Available
Form 1 LRP Screenshots	Form and Instruction	New	Available
Form 1 EGRP Meeting	Form and Instruction	New	Repair queued
Form 1 Survey	Form and Instruction	New	Available
Form 1 Online Survey	Form and Instruction	New	Available
Form 1 NLM Cat Index Cat Survey (Screenshots)	Form and Instruction	New	Available
Form 1B Routine Customer Feedback Form (Screenshots)	Form	New	Available
Form 1 Routine Customer Feedback Form	Form	New	Available
Form 1 NLM Survey Instument	Form and Instruction	New	Available
Form 2 Individual Interviews Moderator's Guide	Form and Instruction	New	Available
Form 1 Group Interviews Moderator's Guide	Form and Instruction	New	Available
Form 4 Support Person Protocol	Form and Instruction	New	Available
Form 3 Patient Protocol	Form and Instruction	New	Available
Form 5 System Usability Scale	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 Online Survey	Form and Instruction	New	Available
Form 1 Comment Card	Form and Instruction	New	Repair queued
Form 1 Online Card Sort	Form and Instruction	New	Available
Form 1 Practicum Participant Survey	Form and Instruction	New	Available
Form 1 Health Planner Survey	Form and Instruction	New	Available
Form 1 Survey	Form and Instruction	New	Available
Form 1 Focus Groups	Form and Instruction	New	Repair queued
Generic_Clearance_Submission_Template1 (2).doc	Supplementary Document	Uploaded 2011-11-29	Available
SSA Generic NIHWide Fast Track1.docx	Supporting Statement A	Uploaded 2011-11-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214692	It's a Noisy Planet. Protect Their Hearing.® Campaign: Mall Interview Surveys	Form	New	Parent/Guardian Interview Survey
214692	It's a Noisy Planet. Protect Their Hearing.® Campaign: Mall Interview Surveys	Form	New	Adolescent Interview Survey
214692	It's a Noisy Planet. Protect Their Hearing.® Campaign: Mall Interview Surveys	Form and Instruction	New	Parent/Guardian Recruitment Screener and Consent Form
214692	It's a Noisy Planet. Protect Their Hearing.® Campaign: Mall Interview Surveys	Form and Instruction	New	Adolescent Recruitment Screener and Consent Form
214275	Usability testing of PHPartners.org website	Form and Instruction	New	PHP Screenshots
212287	Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals	Form and Instruction	New	Survey Screenshots
211839	NLM SIS Anatomy Physiology Portal Resources Survey	Form and Instruction	New	Attachment 2_NLM SIS Anatomy Physiology Portal Resources Survey Instrument Screenshots
211771	NLM AIDS Portal Survey	Form and Instruction	New	Attachment 2_NLM AIDS Portal Survey Screenshots
211686	Office of Equity, Diversity, and Inclusion (EDI) Customer Service Survey	Form and Instruction	New	EDI Customer Service Survey
211552	Outreach Librarians and Library Directors Competencies Assessment	Form and Instruction	New	NLM LO Outreach Focus Group Survey Tool
211400	User Satisfaction Assessment with MeSH and MeSH Indexing	Form	New	Survey
210633	Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist	Form and Instruction	New	Interview Guide
210515	Genetic and Rare Diseases Information Center Customer Satisfaction Survey	Form	New	Script
210515	Genetic and Rare Diseases Information Center Customer Satisfaction Survey	Form and Instruction	New	Survey Screenshots
210313	Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist	Form and Instruction	New	Moderator Guide -Young Faculty
209665	Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist (Interviews)	Form and Instruction	New	Woman Physician-Scientist -Interview Guide
209665	Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist (Interviews)	Form and Instruction	New	Research Dean Interview Guide
209556	Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist	Form and Instruction	New	Recruitment and Screening Form
209556	Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist	Form and Instruction	New	Research Student Modertaor Guide
209556	Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist	Form and Instruction	New	Young Faculty Moderator Guide
209353	NHLBI Health Information Center (HIC) Customer Satisfaction Survey Plan	Form and Instruction	New	Online Survey
209353	NHLBI Health Information Center (HIC) Customer Satisfaction Survey Plan	Form and Instruction	New	Telephone Survey
209052	User Survey for finding aids software/application and website	Form and Instruction	New	Finding Aid Survey
208326	NCI Patient Education Publications Survey	Form and Instruction	New	NCI Patient Education Publications Survey
207444	NIAMS KAI's Client Survey	Form and Instruction	New	Client Survey
207377	NLM Emergency Access Initiative Satisfaction Survey	Form and Instruction	New	EAI Satisfaction Survey
207185	Traveling Exhibition Host Survey	Form and Instruction	New	Traveling Exhibition Host Survey
207079	ClinicalTrials.gov Results Database Train-the-Trainer Workshop Feedback Survey	Form and Instruction	New	Train-the-Trainer Workshop Feedback Survey
207031	Grants Process Satisfaction Survey	Form and Instruction	New	Researcher Survey Text Version
207031	Grants Process Satisfaction Survey	Form and Instruction	New	Researcher Survey
206830	Advocacy Organization Interviews	Form and Instruction	New	Advocate Interview Guide
206778	Omnibus Survey of General Satisfaction with NIH Communication Issues	Form and Instruction	New	Omnibus Survey
206687	NCCAM Customer Service Data Collection for the NCCAM Clinical Digest e-Newsletter	Form and Instruction	New	NCCAM Clinical Digest e-Newsletter Survey
206583	User Survey for IHM database and website	Form and Instruction	New	IHM Survey
206397	It's a Noisy Planet. Protect Their Hearing. Campaign: Customer Satisfaction Survey	Form and Instruction	New	Parent Survey
206397	It's a Noisy Planet. Protect Their Hearing. Campaign: Customer Satisfaction Survey	Form and Instruction	New	Customer Satisfaction Survey
206331	NCAAM Clearinghouse Telephone Survey	Form and Instruction	New	NCAAM Clearinghouse Telephone Survey
206192	Loan Repayment Program Survey: Renewal Application Process	Form and Instruction	New	LRP Screenshots
205992	NCI Epidemiology and Genomics Research Program (EGRP) Sequencing Meeting Planning Survey	Form and Instruction	New	EGRP Meeting
205914	Survey on Interlibrary Loan/Resource Sharing Needs in the National Network of Libraries of Medicine, 2013	Form and Instruction	New	Survey
204703	NIH Office of the Ombudsman, Center for Cooperative Resolution, user feedback survey	Form and Instruction	New	Online Survey
204114	NLM IndexCat User Survey	Form and Instruction	New	NLM Cat Index Cat Survey (Screenshots)
203481	NLM Routine Customeer Feedback Collection	Form	New	Routine Customer Feedback Form (Screenshots)
203481	NLM Routine Customeer Feedback Collection	Form	New	Routine Customer Feedback Form
203095	Web-based Survey of DIRLINE database (NLM)	Form and Instruction	New	NLM Survey Instument
202855	Requirements Gathering for Patient-Centered Communication (PCC) Web-based Application for NCI	Form and Instruction	New	Individual Interviews Moderator's Guide
202855	Requirements Gathering for Patient-Centered Communication (PCC) Web-based Application for NCI	Form and Instruction	New	Group Interviews Moderator's Guide
202855	Requirements Gathering for Patient-Centered Communication (PCC) Web-based Application for NCI	Form and Instruction	New	Support Person Protocol
202855	Requirements Gathering for Patient-Centered Communication (PCC) Web-based Application for NCI	Form and Instruction	New	Patient Protocol
202855	Requirements Gathering for Patient-Centered Communication (PCC) Web-based Application for NCI	Form and Instruction	New	System Usability Scale
202589	National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Customer Satisfaction Survey	Form and Instruction	New	Survey
202511	Semi-structured telephone interview for end users who are stakeholders in PROMIS	Form and Instruction	New	Survey
202388	ONLINE SURVEY FOR NIDCD INSIDE NEWSLETTER	Form and Instruction	New	Online Survey
202286	Comment Card for Soliciting Feedback on NEI Public Inquiry Response	Form and Instruction	New	Comment Card
202170	OBSSR Online Card Sort	Form and Instruction	New	Online Card Sort
202135	Practicum Participant Survey	Form and Instruction	New	Practicum Participant Survey
202020	National Multicultural Outreach Initiative (NMOI) Pilot Study	Form and Instruction	New	Health Planner Survey
201949	NIAMS KAI's Client Survey	Form and Instruction	New	Survey
201316	Focus Groups on Interlibrary Loan/Resource Sharing Needs in the National Network of Libraries of Medicine	Form and Instruction	New	Focus Groups

ICR Details

OMB Control No: 0925-0648	ICR Reference No: 201112-0925-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (OD/OER)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/12/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/06/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved
Responses	759,000	0	0
Time Burden (Hours)	148,074	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the National Institutes of Health to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the agency's programs.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 80542	12/22/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 74802	12/01/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 44

table that charts list of burden

IC Title	Form No.	Form Name
Advocacy Organization Interviews	1	Advocate Interview Guide
ClinicalTrials.gov Results Database Train-the-Trainer Workshop Feedback Survey	1	Train-the-Trainer Workshop Feedback Survey
Comment Card for Soliciting Feedback on NEI Public Inquiry Response	1	Comment Card
Focus Groups on Interlibrary Loan/Resource Sharing Needs in the National Network of Libraries of Medicine	1	Focus Groups
Genetic and Rare Diseases Information Center Customer Satisfaction Survey	1, 2	Survey Screenshots ,   Script
Grants Process Satisfaction Survey	1, 2	Researcher Survey ,   Researcher Survey Text Version
It's a Noisy Planet. Protect Their Hearing. Campaign: Customer Satisfaction Survey	1, 2	Customer Satisfaction Survey ,   Parent Survey
It's a Noisy Planet. Protect Their Hearing.® Campaign: Mall Interview Surveys	1, 2, 3, 4	Adolescent Recruitment Screener and Consent Form ,   Parent/Guardian Recruitment Screener and Consent Form ,   Adolescent Interview Survey ,   Parent/Guardian Interview Survey
Loan Repayment Program Survey: Renewal Application Process	1	LRP Screenshots
NCAAM Clearinghouse Telephone Survey	1	NCAAM Clearinghouse Telephone Survey
NCCAM Customer Service Data Collection for the NCCAM Clinical Digest e-Newsletter	1	NCCAM Clinical Digest e-Newsletter Survey
NCI Epidemiology and Genomics Research Program (EGRP) Sequencing Meeting Planning Survey	1	EGRP Meeting
NCI Patient Education Publications Survey	1	NCI Patient Education Publications Survey
NHLBI Health Information Center (HIC) Customer Satisfaction Survey Plan	1, 1	Telephone Survey ,   Online Survey
NIAMS KAI's Client Survey	1	Client Survey
NIAMS KAI's Client Survey	1	Survey
NIH Office of the Ombudsman, Center for Cooperative Resolution, user feedback survey	1	Online Survey
NLM AIDS Portal Survey	1	Attachment 2_NLM AIDS Portal Survey Screenshots
NLM Emergency Access Initiative Satisfaction Survey	1	EAI Satisfaction Survey
NLM IndexCat User Survey	1	NLM Cat Index Cat Survey (Screenshots)
NLM Routine Customeer Feedback Collection	1, 1B	Routine Customer Feedback Form ,   Routine Customer Feedback Form (Screenshots)
NLM SIS Anatomy Physiology Portal Resources Survey	1	Attachment 2_NLM SIS Anatomy Physiology Portal Resources Survey Instrument Screenshots
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Customer Satisfaction Survey	1	Survey
National Multicultural Outreach Initiative (NMOI) Pilot Study	1	Health Planner Survey
OBSSR Online Card Sort	1	Online Card Sort
ONLINE SURVEY FOR NIDCD INSIDE NEWSLETTER	1	Online Survey
Office of Equity, Diversity, and Inclusion (EDI) Customer Service Survey	1	EDI Customer Service Survey
Omnibus Survey of General Satisfaction with NIH Communication Issues	1	Omnibus Survey
Outreach Librarians and Library Directors Competencies Assessment	1	NLM LO Outreach Focus Group Survey Tool
Practicum Participant Survey	1	Practicum Participant Survey
Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist	3, 2, 1	Young Faculty Moderator Guide ,   Research Student Modertaor Guide ,   Recruitment and Screening Form
Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist	1	Moderator Guide -Young Faculty
Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist	1	Interview Guide
Qualitative Research to Explore Young People's Choices to Pursue a Career as a Physician Scientist (Interviews)	1, 2	Research Dean Interview Guide ,   Woman Physician-Scientist -Interview Guide
Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals	1	Survey Screenshots
Requirements Gathering for Patient-Centered Communication (PCC) Web-based Application for NCI	3, 5, 4, 1, 2	System Usability Scale ,   Patient Protocol ,   Support Person Protocol ,   Group Interviews Moderator's Guide ,   Individual Interviews Moderator's Guide
Semi-structured telephone interview for end users who are stakeholders in PROMIS	1	Survey
Survey on Interlibrary Loan/Resource Sharing Needs in the National Network of Libraries of Medicine, 2013	1	Survey
Traveling Exhibition Host Survey	1	Traveling Exhibition Host Survey
Usability testing of PHPartners.org website	1	PHP Screenshots
User Satisfaction Assessment with MeSH and MeSH Indexing	1	Survey
User Survey for IHM database and website	1	IHM Survey
User Survey for finding aids software/application and website	1	Finding Aid Survey
Web-based Survey of DIRLINE database (NLM)	1	NLM Survey Instument

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	759,000	0	0	759,000	0	0
Annual Time Burden (Hours)	148,074	0	0	148,074	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $350,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/06/2011

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